Provider Demographics
NPI:1366522427
Name:PHILLIPS, ANDREW F (MD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:F
Last Name:PHILLIPS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 W. HUNTINGTON DRIVE
Mailing Address - Street 2:SUITE 605
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-3462
Mailing Address - Country:US
Mailing Address - Phone:626-446-1600
Mailing Address - Fax:626-446-9986
Practice Address - Street 1:301 W HUNTINGTON DR
Practice Address - Street 2:SUITE 605
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-3462
Practice Address - Country:US
Practice Address - Phone:626-446-1600
Practice Address - Fax:626-446-9986
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG78557152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAY26956Medicare UPIN
CAW18397Medicare ID - Type UnspecifiedMEDICARE